Just five months after President Clinton's first self-imposed deadline for a health care plan passed, doctors, consumers, and medical students are all busy scratching their heads as they try to understand the plan, unveiled to the American public Wednesday night.
Beset with the reality of an expensive health care system that fails to cover 37 million Americans, experts at Harvard and elsewhere are looking to Clinton's plan with a glint of hope--but also a sea of worries.
The plan, which seeks to limit a family's out-of-pocket medical expenses to $3,000 a year, received mixed reviews from all corners of the health care community. Some experts, citing Clinton's vigorous call to arms, were enthusiastic that his spirit would prevail and allow some form of the plan to pass through Congress.
But others questioned various aspects of the proposal, from important details Clinton omitted, to outright doubt that the plan would help those who most need it.
Clinton's long-awaited proposal, ready in some states by 1995, would have workers in a given area pay equal rates for equal coverage. Workers would keep their insurance if they lost a job or changed jobs.
But it appears that many citizens will be forced to give up the precious right of choosing their doctors, or at least pay more for that privilege.
And some experts, while supporting theunderlying themes and message of the plan, saythere are more problems. For example, says Dr.Daniel D. Federman, dean for medical education atHarvard Medical School, the quality of care maynot be sufficiently championed in thenegotiations.
"I would like to see an explicit address topreserving quality and preserving education, andI'm concerned they are less well spoken for in thepresent design than universality, simplificationof paperwork, et cetera," he says.
And on the physicians' side, says one currentMedical School student, Clinton's plan may alsopose special potential problems for medicalstudents, including the freedom to choose theirarea of specialization.
Steve N. Kalkanis `93, a first-year MedicalSchool student, says the plan might require acertain number of graduates to become familypractitioners, thereby limiting the number ofresidencies in specialties. The cause for primarycare has been championed for several years, andsome organizations have called for a quota formedical school graduating classes of 50 percentprimary care physicians.
"As a med student, I'm still guarded and prettyskeptical," says Kalkanis.
But Kalkanis said he was comforted by Clinton'sreassurance that doctors were not the problem withthe health care system. "I'm somewhat relieved hemade an effort to emphasize that doctors weresomething good that should stay. He sent out amessage that he's not out to hurt the physiciansand the medical profession," he says.
Federman, who says he supports the underlyingprinciples of the plan, said he could not predict,as dean of medical education, what effectClinton's reforms would have on medical schools.
"Enrollment in medical school for six years hasbeen a growth industry, and the figures havealready surpassed those of last year," saidFederman. "What it will do in two years, smartdoctors don't predict."
Federman says he supports the plan's attempt tobreak the link between insurance and employmentstatus, its effort to control costs and especiallyits coverage of medication and long-term care forthe elderly.